Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.

Brown, Richard P.; Gelberman, Richard H.; Seiler, John G.; Abrahamsson, Sven-Olof; Weiland, Andrew J.; Urbaniak, James R.; Schoenfeld, David; Furcolo, Deborah.

doi:10.2106/00004623-199309000-00002

Cited by 432 publications

(322 citation statements)

References 21 publications

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“…DISCUSSION Ninety-three per cent of our patients who underwent OCTR with the short incision resumed regular ADL within 28 days. This finding compares favourably with ECTR results for the resumption of ADL, for which studies report a range of 60.4% to 85.9% within 28 days (3,7,8), a mean of 20.7 to 39.8 days (7,9,10) or a median of 14 to 25 days (11,12). Two studies reported on a similar short OCTR technique.…”

Section: Resultssupporting

confidence: 59%

Open carpal tunnel release: Comparison of a long versus short incision

Kruger¹,

Rebot²

1998

CAN J PLAST SURG

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A review of our patients who had been treated with open carpal tunnel release (OCTR) undertaken in 1991 revealed that 78% had an uneventful course of recovery, resuming full function within two to four weeks, and that 25% required out-patient rehabilitation due to the persistence and magnitude of their symptoms three to four weeks postoperatively. Resumption of activities of daily living (ADL) was delayed by weakness, peri-incisional tenderness, restricted range of movement and swelling.In an effort to decrease postoperative morbidity and shorten recovery time, our surgical protocol was re-examined. Decreased postoperative discomfort and shorter recovery A total of 225 adults with carpal tunnel release of 313 wrists were studied to compare the outcome of a long (at least 3.5 cm) with that of a short (2.0 cm or less) incision technique. The two groups were compared for postoperative complaints, length of time until full function was regained, rate of referral to rehabilitation and the effect of Workers' Compensation status. The surgical technique and rehabilitation protocol are described. The number and severity of postoperative complaints were significantly reduced in the short incision group. In the non-Workers' Compensation group, 96% of short incision patients resumed full function within 28 days. This finding compares favourably with published results for endoscopic release, and is superior to results obtained with the long incision. Workers' Compensation patients required longer to recuperate, with 78% regaining full function within 28 days. Of those with Workers' Compensation, 47% of the long incision group and 27% of the short incision group required out-patient therapy. For the non-Workers' Compensation group, this percentage decreased to 21% of those with the long incision and 3% with the short incision. A history of vocational or avocational repetitive motion patterns was the most common indicator for therapy and accounted for 67% of rehabilitation referrals. Key Words: Adult, Carpal tunnel release, Median nerve, Occupational therapy, Physical therapy, Treatment outcomeDégagement ouvert du canal carpien : comparaison d'une incision longue versus courte RÉSUMÉ : En tout, 225 adultes ayant subi un dégagement du canal carpien, totalisant 313 poignets, ont été étudiés afin de comparer les résultats d'une technique d'incision longue (au moins 3,5 cm) versus courte (2,0 cm ou moins). Les deux groupes ont été comparés au chapitre des plaintes postopératoires, du temps de retour à un fonctionnement normal, du taux de demandes auprès des programmes de réadaptation et de l'effet sur la compensation par la CSST. La technique chirurgicale et le protocole de réadaptation sont décrits. Le nombre et la gravité des problèmes postopératoires ont été significativement moindres dans le groupe ayant subi l'incision courte. Pour le groupe non inscrit à la CSST, 96 % des patients ayant subi une incision courte ont retrouvé un fonctionnement normal en 28 jours. Ces résultats se comparent favorablement aux résultats publiés a...

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Section: Resultssupporting

confidence: 59%

Open carpal tunnel release: Comparison of a long versus short incision

Kruger¹,

Rebot²

1998

CAN J PLAST SURG

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“…1,4,5,27,36) However, a significant number of patients with clinical problems must be followed up or treated in the postoperative period. Sonography is helpful either to confirm the decompressive surgery or to identify the problems in patients who fail to improve.…”

Section: Discussionmentioning

confidence: 99%

“…Sonography achieves a diagnostic sensitivity of 89% and specificity of 83% for CTS. 5) Compared with other techniques (nerve conduction study, magnetic resonance imaging, computed tomography), sonography is well tolerated by the patients, especially for repeat studies. Sonography is both time-saving and cost-effective compared to the other diagnostic techniques.…”

Section: Discussionmentioning

confidence: 99%

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Çolak

Kutlay

Pekkafalı

et al. 2007

Neurol. Med. Chir.(Tokyo)

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The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.

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“…Persistent symptoms, which could suggest intraneural fibrosis or incomplete division of the transverse carpal ligament, occurred in only 7% of cases, which is lower than in other series. 6,7 We observed higher rates of scar tenderness and persistent symptoms in the group operated on by registrars (Fig. 1).…”

Section: Discussionmentioning

confidence: 71%

Study to Assess Differences in Outcome Following Open Carpal Tunnel Decompressions Performed by Surgeons of Differing Grade

Akhtar

Sinha

Bradley

et al. 2007

annals

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INTRODUCTION Carpal tunnel decompression is the most commonly performed surgical procedure within a hand unit. Although very effective, the complications following the procedure can be significant. In an attempt to identify the causes of such complications, we assessed whether seniority of the surgeon impacts on outcome for open carpal tunnel decompression.PATIENTS AND METHODS Data were jointly and prospectively gathered from two units from either side of the Atlantic -the Pulvertaft Hand Center, UK and the Curtis Hand Center, USA. The aim of the study was to assess outcome following carpal tunnel decompression. Completed data were gathered following open carpal tunnel decompression on 352 hands. Surgeons of a consultant grade had performed 123 of these procedures whilst surgical trainees had performed 229 of the procedures. Assessment was by Levine Katz questionnaire results, Semmes-Weinstein testing, grip strength and pinch grip strength testing performed both pre-operatively and 6 months' postoperatively. Complications following the procedure were also recorded. RESULTS Mean results were found to be better in those patients where the surgeon was of a consultant grade. However, this was only found to be of statistical significance on Semmes-Weinstein testing. Complications following the procedure were also noted to be higher in the group of patients operated on by trainee grades.CONCLUSIONS Our results show the carpal tunnel decompression performed by a surgeon of consultant grade offers slightly better results in objective neurological testing when compared with those performed by a more junior grade.

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Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods.

Cited by 432 publications

References 21 publications

Open carpal tunnel release: Comparison of a long versus short incision

Open carpal tunnel release: Comparison of a long versus short incision

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Study to Assess Differences in Outcome Following Open Carpal Tunnel Decompressions Performed by Surgeons of Differing Grade

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